pqcnc april nas webinar: opqc - improve consistency in

8/9/2019 PQCNC April NAS Webinar: OPQC - Improve Consistency in

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OPQC

Ohio Perinatal QualityCollaborative


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The Ohio Perinatal QualityCollaborative

Obstetrics Neonatal39-WeekSchedule

dDeliveries withoutedicalindicatio

n

Steroids !orwoen at risk

!or "reterbirth

#$%&'( - 33 )'(*Done Transitionto +C Surveillance

,ncrease +irth

Dataccurac

y .Onlineodule

s

S"read

to allaternit

yhos"italsin Ohio

2014:

Progesteroneto Reduce

Preterm BirthRisk

+loodStrea

,n!ections/

0i1h

reliabilityo! lineaintenance bundle

2se o!huanilk inin!ants

$$-$9weeks

$&4%/

NeonatalbstinenceSyndroe

OC0NS in) C05s


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Proedica Toledo

Children5s

6iai7alley

6ercy nderson

ultan

6t8 Carel astOS2

20 :ainbow+abies .Children5s

+ethesda North0os"ital

NationwideDublin

6ethodist

kron Children5s Su

a

CincinnatiChildren5s

0illcrest 0os"ital;airview

0os"ital

Cleveland Clinic

DaytonChildren5s

Nationwide :iverside6ethodist

Nationwide rant

Nationwide 6t8 Carel St8

nn5s

20 Cincinnati

od Saaritan0os"ital

6etro0ealth

6t8 Carel WestNationwide Doctor5s

kron Children5s

Nationwide Children5s

6ercyChildren5s0os"ital

triu 6edical Center

;ort 0ailton

6ercy 0os"ital ;air


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=ey Driver Dia1raProject Name: OPQC Neonatal NAS Leader: Walsh

SMART AIM

KEY RI!ERS INTER!ENTIONS

By increasingidentifcation o and

com!assionate"ithdra"al treatmentor ull#term inants$orn "ith %eonatal

&$stinence

'yndrome (%&')* "e"ill reduce length ostay $y 20+ across

!artici!ating sites $y ,une 30* 201-.

m!rove recognition andnon#udgmental su!!ort or%arcotic addicted "omen

and inants

onnect "ith out!atientsu!!ort and treatment

!rogram !rior to discharge

'tandardie %&' reatmentProtocol

!timie %on#Pharmacologic R5 Bundle • nitiate R5 %&' score 6 7 t"ice.

•'ta$iliation/ 8scalation Phase•9ean "hen sta$le or 47 hrs $y10+ daily.

•'"addling* lo" stimulation.•8ncourage kangaroo care

•eed on demand# ;B; ia!!ro!riate or lactose ree* 22 calormula

•&ll ;< and R% sta= to vie" >%urturethe ;other# %urture the hild?•;onthly education on addiction care

ttain hi1hreliability in NS

scorin1 bynursin1 sta@

Partner "ith amilies to8sta$lish 'aety Plan or

nant

;ulltie :N sta@ at >evel $ and3 to co"lete D5"olito NSscorin1 trainin1 video andachieve 9&A reliability8

• 8sta$lish agreement "ith out!atient!rogram and/or ;ental @ealth•Atilie 8arly ntervention 'ervices

olla$orate "ith


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OPQC NAS Project Aim

• Develop and implement a standardized process for the

identification, evaluation, treatment and dischargemanagement of an infant with neonatal abstinence

syndrome..

– Standardization of Scoring Tool

– Standardization of protocol bundles

• Non-parmacological !undle• Parmacological Treatment !undle

• Create a culture of compassion, understanding, and

healing for the mother infant dyad affected by the

problem of neonatal abstinence syndrome.

Te aim of te OPQC NAS Project is to increase the identification of andcompassionate withdrawal treatment for full-term infants born with !""

tereb# reducing te lengt of sta# for tese infants b# $%& across participating

sites b# 'une (%" $%)*.


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#mportance of !ssessment$what are we assessing%

Neonatal +itdra,al• Onset $ ours to da#s

• /uration )0 da#s to monts" self limiting

• AAP 1onitoring 2ecommendations

3 1inimum $-( da#s for an# maternal istor# ofdrug use

3 *-4 da#s if mom on multiple and5or long acting

drugs


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&hat is #nter-'ater 'eliability%

• #nter-rater 'eliability( e6tent to ,ic $

• pro7iders agree ,en using te same tool.

• )ethod( one person scores" ,ile

anoter

• obser7es8 eac independentl# scores"

ten

• compare

• *oal( 9%& inter-rater reliabilit#


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!" "coring by Clinical "taff Cohort +


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NAS Scoring b# Clinical Staff Coort $

&ll ulltime nursing sta= in our %/A com!lete the


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m!rove onsistency in

;odifed innegan 'coring• &ll sites use same tool

•

rain R% sta= to E0+ relia$ilityin scoring using


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;inne1an Scorin1 D7D .Workbook htt!://""".neoadvances.com/


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………………..……………………………………………………………………………………………………………………………………..

;inne1anScorin1 Tool

8rin L. Heels ;'* &PR%* %%P#B%&' askorce hair

%%P Program


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………………..……………………………………………………………………………………………………………………………………..

9hy use an assessmenttoolI

• 200- study: 71+ centers surveyed use assessmenttool* -2+ have guidelines (rocetti* &min* J ,ansonn* 200D)

• &llo"s or >common language?* decrease varia$ility*involve amilies

• Based on o!iate "ithdra"al

3 ne tool or all su$stance "ithdra"alI

• onounding actors

3 erm vs. !reterm vs. $eyond neonatal !eriod

3 'ta= training and com!etency maintenance 3 'u$ectivity


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………………..……………………………………………………………………………………………………………………………………..

NAS Assessment Tools


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………………..……………………………………………………………………………………………………………………………………..

>;odifed innegan?

• Originall# de7eloped in )94*8 :1odified; in )9


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………………..……………………………………………………………………………………………………………………………………..

innegan 'cored tems

Central NervousSyste

85cessive rying (2#3)

'lee! (1#3)

@y!eractive ;oro (2#3) remors (1#4)

ncreased muscle tone(2)

85coriation (1)

;yoclonic erks (3)

onvulsions (-)

utonoic NervousSyste

'"eating (1)ever (1#2)

reKuent a"ning (1)

;ottling (1)%asal 'tuMness (1)

'neeing (2)%asal laring (2)Res! rate (1#2)

astrointestinalSyste85cessive sucking (1)

Poor

eeding (2)

Regurgitation (2)

Proectile

Nomiting (3)'tools (2#3)


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………………..……………………………………………………………………………………………………………………………………..

%@ innegan raininginnegan raining ourses ( ;arch# &!ril 2010)

"o hal day %&' 9orksho!s rain the trainer ormat

m!lement standardied training o ne" sta=

"ith commercially !roduced !rogram(%eo&dvancesO)

ngoing com!etency or all sta= :eliabilityB e5tent to "hich 2 !roviders agree "hen using

the same tool.

6ethodB one !erson scores* "hile another o$serves eachinde!endently scores* then com!are

oalB E0+ inter#rater relia$ility


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i t t


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………………..……………………………………………………………………………………………………………………………………..

ngoing nter#raterRelia$ility

2013 %@ 'ta= 'urvey on innegan'coring:

• CD+ o R% sta= res!onded

• 1-.2 + elt some"hat or not comorta$le

concerns: scoring o slee! or older $a$ies*

e5coriation

• 3D+ "anted more education/training

• 2C+ o sta= "ere not conducting inter#rater relia$ility scoring !ro!erly


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………………..……………………………………………………………………………………………………………………………………..

Results• 2013 all R%s "atched: >&ssessing signs and

sym!toms o %eonatal &$stinence using the

innegan 'coring ool? video rom %eo&dvances

• %&' 'u!er Asers reeducated all sta=

• Lunch nF Learns "ith 2013 N% i%G %&'9e$inars

•


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PG Resources

• o!Kc.net Proects %&'Learning 'essions &rchives ,une2C* 2014 1:10#1:-0!m J 1:--#

2:3-!m innegan 'coring (Heels)

1D minute video o this !resentation is

on our "e$site

https://opqc.net/sites/bmidrupalpopqc.chmcres.cchmc.org/files/Learning%20Sessions/June%2026,%202014%20Learning%20Session/Neo%20(3)%20110-150pm%20and%20155-235pm%20Finnegan%20Scoring%20(Keels).pdfhttps://opqc.net/sites/bmidrupalpopqc.chmcres.cchmc.org/files/Learning%20Sessions/June%2026,%202014%20Learning%20Session/Neo%20(3)%20110-150pm%20and%20155-235pm%20Finnegan%20Scoring%20(Keels).pdf


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P


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9hat are other hos!itals testingISteal Shaelessly-Share Sealessly

• @ave a !arent o$serve and !artici!ate "hen thenurse com!letes the inantFs scoring.

• rack an additional varia$le o the inant "eight onthe 'coring ool.

• eed the inant !rior to scoring does this im!act thescoreI

• ncrease inter#rater relia$ility among %A sta=other sites are "orking on this "ith their Post Partumand/or %e"$orn %ursery nursing sta=.


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pqcnc april nas webinar: opqc - improve consistency in

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